As a practicing internist, I have followed the gamut of the sturm and drang surrounding interoperability, and have experienced its pros and cons first hand.
What’s important now is that interoperability must evolve into population health management and value-based care use cases to match where healthcare delivery and payment is quickly going. Along with the approaching permanence of alternative payment models, population-based payments, either condition-specific or comprehensive, are on the ONC/CMS roadmap.
The FHIR API can can advance how the healthcare industry exchanges data, and not just for EMRs. All healthcare information technology products—from lab systems to HIEs, and even population health management tools—will have the opportunity to leverage the new framework.
The premise of FHIR is that HIT vendors will expose the API endpoints detailed in the specification, which can then be accessed by anyone who is properly authenticated and authorized. There are numerous API functions that FHIR supports, including both putting data into and getting data out of vendors who support the API. For example, FHIR provides endpoints for lab results, procedures, medications and documents, among others.
To play out in the population health arena, there are certain use cases that should have prominence.
Two FHIR use cases that fit
One is the scenario of providers using an EMR as their main workflow tool, but needing population health alerts for their patients.
Because accurate alerts require a complete and precise longitudinal chart, EMRs simply do not have the analytics capability to offer an automated view. Tools used for population health management should inherently offer such a complete longitudinal chart.
The difficulty in this instance for providers is one of workflow; specifically, having to use two separate tools. Furthermore, having to leave the EMR, log in to a separate application, search for a patient again, and adjust one’s mindset to a completely new screen layout is difficult, and makes an already cumbersome EMR process even more onerous.
A FHIR specification for an alert API means that rather than leaving their EMR, providers can have their EMR call the alert API of their population health management tool, get the alert data on the fly, and have the EMR render it in real time in the patient’s chart.
A second use case for FHIR and population health revolves around care plans and care management. Because population health management tools offer actionable data, they serve as better tools for care managers who need the complete picture of a patient’s health in order to make informed decisions about care plans.
Providers, however, generally use their EMR as the primary point of data entry. This discrepancy in workflow creates an information barrier between the care managers who update care plans and the providers who enter data into the EMR. To remedy this, FHIR should allow for a care plan API, which can be leveraged to bridge the potential gap in tools. Specifically, if the EMR supports the care plan API, the population health management tool can push updated care plans to the EMR for the provider’s use.
Interoperability is such a loaded term that the health IT industry and federal regulators often get bogged down in measurement and lose sight of the goals and value that should drive data exchange.
By that I mean the willingness to share data within specific purpose-driven approaches or use cases. That’s how the tangible value of data exchange is mined to match what’s really desired by providers on the care delivery front lines. This is as much a cultural challenge as technological.
And value-based care requires high-volume data exchange. Interoperability at the population level requires automation, flexibility and scale. To get there, interoperability needs to be redefined to fit the processes of population health management and reimbursement on that scale.
In terms of data liquidity it means patient data aggregation across health system EMRs and running the data through quality, risk stratification and analytics metrics. Once patient data is scrubbed through and the needs of a patient population are known, clinically relevant care management leads to better outcomes (and contracting leverage).
Success in moving from fee-for-service to value-based care or population-based payments will require interoperability frameworks that push the boundaries of how we exchange data into a more purpose-driven emphasis. FHIR is a means to this end, and use cases needed for population health will require collaboration and buy-in from ONC’s API Task Force, the HL7 Argonaut Project and other stakeholders.
Paul Taylor is co-founder and CMIO of Wellcentive.
The concept of producer surplus may begin to apply here. This is simply stated: Is there enough dough in the system to get the innovators in interoperability incented to apply HIT to population health management and to value-based care? [what you said you wanted.]…and anything else?
All healthcare prices are increasing. Unless incomes increase, this means that the marginal revenue available to innovators in health care will gradually decrease, reducing producer surplus. IOW high prices will grind everything to a halt.
No amount of calling it “interoperability” will make it so.